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Economic analysis of biomarker-based anti-EGFR therapies in metastatic colorectal cancer in the Austrian context

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Summary

Background

In metastatic colorectal cancer (mCRC), multimodal therapeutic strategies and diagnostics have continuously improved patient survival. The aim of our investigation was to relate this enhanced clinical outcome to treatment costs based on predictive biomarker scenarios guiding epidermal growth factor receptor (EGFR) targeting in a developed country.

Methods

We performed a cost-effectiveness analysis for the combination of EGFR inhibitors with chemotherapy in the first-line treatment of mCRC. Resource use estimates were based on actual data from two oncological departments and on clinical outcomes adapted from published trials. Comparative analyses for the use of EGFR inhibitors were based on three biomarker scenarios (sensitivity: 35%, 55% and 75%) to estimate their incremental cost-effectiveness and were completed by sensitivity analyses.

Results

Using FOLFIRI+cetuximab, preselection for EGFR therapy with KRAS testing prolonged progression-free survival with average savings of 913 €/month/patient (scenario 1) and average savings of 1811 €/month/patient when testing the whole RAS-family (scenario 2). In a future but realistic scenario, up 39% of treatment costs could be saved with almost three life–years gained (LYG).

The incremental cost/LYG was 212,083 € (116,646–1,866,332 €) for unselected EGFR therapy, 32,251 € (30,294–43,488 €) for EGFR following KRAS testing, 19,172 € (15,369–28,611 €) for the all RAS scenario, and 12,369 € (3865–18,533 €) for a future biomarker scenario.

Conclusions

In the therapy of mCRC, predictive biomarker testing has shown to be effective and cost saving. For further improvement, a strong research focus on predictive biomarkers is considered highly efficient to promote precision oncology by alleviating the pressure on the healthcare system.

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Acknowledgements

The data were partly presented at WCGC (World Congress on Gastrointestinal Cancers) in Barcelona in 2015.

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Authors and Affiliations

  1. Department of Medicine I, Centre for Oncology, Haematology and Palliative Care, Wilhelminenspital, Montleartstraße 37, 1160, Vienna, Austria

    Dora Niedersüß-Beke

  2. Department of Health Economics, Centre for Public Health, Medical University of Vienna, Vienna, Austria

    Judit Simon

  3. Ludwig Boltzmann Institute Applied Diagnostics, Vienna, Austria

    Judit Simon

  4. Interdisciplinary Institute of Management and Organizational Behaviour and Centre for Empirical Research Methods, Vienna University of Economics and Business, Vienna, Austria

    Michael Schiffinger

  5. Department of Medicine I, Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria

    Robert M. Mader

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Correspondence to Dora Niedersüß-Beke.

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D. Niedersüß-Beke, J. Simon, M. Schiffinger, and R.M. Mader declare that they have no competing interests.

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Niedersüß-Beke, D., Simon, J., Schiffinger, M. et al. Economic analysis of biomarker-based anti-EGFR therapies in metastatic colorectal cancer in the Austrian context. memo 11, 322–329 (2018). https://doi.org/10.1007/s12254-018-0440-y

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